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![KEY CONCEPTS
According to the treat-to-target approach supported by the American
College of Rheumatology (ACR) and European League Against Rheumatism
(EULAR) Guidelines, the goal serum urate concentration is less than 6 mg/dL
[less than 357 μmol/L], or less than 5 mg/dL [less than 297 μmol/L] if signs
of gout persist at a concentration of 6 mg/dL.
Xanthine oxidase inhibitors are preferred agents for the prophylaxis of
recurrent gout attacks because they are effective in both underexcreters
and overproducers of uric acid.
Uricosuric drugs are contraindicated for patients with impaired kidney
function (a creatinine clearance less than 45-50 mL/min).
Due to increased risk of acute kidney injury when used as monotherapy,
lesinurad is only approved to be taken in combination with a xanthine
oxidase inhibitor.](https://image.slidesharecdn.com/gout-230505202305-2d90a472/75/gout-pptx-7-2048.jpg)
gout.pptx
- 1. Gout and Hyperuricemia apt. FarisaLuthfiana, S.Farm, M.Clin.Pharm
- 2. Capaian Pembelajaran Setelah mengikutimatakuliah ini mahasiswa mampu: 1. Memahami patofisiologi RA 2. Memahami terapi rasional pada berbagai kasus RA 3. Mampu mengidentifikasi dan menyelesaikan permasalahan terkait pengobatan RA
- 3. Tujuan Pembelajaran Mahasiswa mampumemilih terapi (b) farmakologi atau pengobatan(c) dengan tepat (d), termasuk terapi non farmakologis, menentukan pedoman pemilihan obat, rekomendasi dosis, monitoring efek samping, pertimbangan farmakokinetik, dan interaksi obat dengan obat lainnya.
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- 6. KEY CONCEPTS In theabsence of a history of gout, asymptomatic hyperuricemia is not usually treated Acute gouty arthritis may be treated effectively with short courses of highdose nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine Initiation of a xanthine oxidase inhibitor may be considered in patients with gout and one of the following indications for urate-lowering therapy (ULT): (a) two or more gout attacks per year, (b) the presence of one or more tophus, (c) a history of urolithiasis, (d) high-risk comorbidities including chronic kidney disease, hypertension, ischemic heart disease, or heartvfailure, (e) first diagnosis of gout at age <40 years, (f) serum uric acidvconcentrations >8.0 mg/dL.
- 7. KEY CONCEPTS According tothe treat-to-target approach supported by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) Guidelines, the goal serum urate concentration is less than 6 mg/dL [less than 357 μmol/L], or less than 5 mg/dL [less than 297 μmol/L] if signs of gout persist at a concentration of 6 mg/dL. Xanthine oxidase inhibitors are preferred agents for the prophylaxis of recurrent gout attacks because they are effective in both underexcreters and overproducers of uric acid. Uricosuric drugs are contraindicated for patients with impaired kidney function (a creatinine clearance less than 45-50 mL/min). Due to increased risk of acute kidney injury when used as monotherapy, lesinurad is only approved to be taken in combination with a xanthine oxidase inhibitor.
- 8. KEY CONCEPTS Low-dose colchicine,NSAID, or corticosteroid therapy should be administered during the first 6 months of urate-lowering therapy (ULT) to minimize the risk of acute gout attacks that may occur during this initiation period.. Uric acid nephrolithiasis should be treated with adequate hydration (2-3 L/day), a daytime urine-alkalinizing agent, and 60 to 80 mEq/day (mmol/day) of potassium bicarbonate or potassium citrate.. Patients with hyperuricemia or a history of gouty arthritis should undergo comprehensive evaluation for signs and symptoms of cardiovascular disease, and aggressive management of cardiovascular risk factors (eg, weight loss, reduction of alcohol intake, control of blood pressure, glucose, and lipids) should be attempted.
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- 10. Prognostic Asymptimatic Hiperuricemia Intercritical phase Tophaceous Gout UricAcid Nephrolithiasis Acute
- 11. Definition The term goutdescribes a heterogeneous clinical spectrum of diseases including elevated serum urate concentration (hyperuricemia), recurrent attacks of acute arthritis associated with monosodium urate (MSU) crystals in synovial fluid leukocytes, deposits of monosodium urate crystals (tophi) in tissues in and around joints, interstitial kidney disease, and uric acid nephrolithiasis
- 12. A decline inthe urinary excretion of uric acid to a concentration below the rate of production leads to hyperuricemia and an increased miscible pool of sodium urate. Overproduction of Uric Acid Underexcretion of Uric Acid Metabolism product Cause Gout Hiperuricemia
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- 15. Management Gout Acute Maintanance Analgetic/ antiinflamation AnalgeticUrate Lowering Therapy
- 16. Algorithm for managementof an acute gout attack. (Algorithm derived from 2017 ACP, 2016 EULAR and 2012 ACR gout guidelines.) Acute Gouty Arthritis
- 17. Management of Hyperuricemiain Gout (maintenance) Algorithm for management of hyperuricemia in gout. (Algorithm derived from 2017 ACP, 2016 EULAR and 2012 ACR goutguidelines.)
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- 19. Uric acid pathwayand targets of drug action. (HGPRT, hypoxanthine- guanine phosphoribosyltransferase; PRPP, phosphoribosyl pyrophosphate.)
- 20. Xantin Oxidase Inhibitor Xanthine oxidaseinhibitors reduce uric acid by impairing the ability of xanthine oxidase to convert hypoxanthine to xanthine and xanthine to uric acid Uricosuric Drugs Uricosuric drugs increase the renal clearance of uric acid by inhibiting postsecretory renal proximal tubular reabsorption of uric acid. Urate Lowering Therapy *Anti-Inflammatory Gout Prophylaxis during Initiation of Pharmacologic Urate-Lowering Therapy *Interleukin-1 Inhibitors